INTRODUCTION: Cardiac arrest in the operating room (OR) environment is a rare but potentially catastrophic event with mortality rates of more than 50%. Contributing factors are known, and the event is generally rapidly recognized, as patients are usually under full monitoring. The nature of the cardiac arrest in the OR is different to other environments as it is not only related to the patient’s conditions but likewise to the anaesthetic and the surgical procedure. The aim of this article is to review recent literature on cardiac arrest in the immediate perioperative environment with a focus on incidence, causes and treatment.EVIDENCE ACQUISITION: Retrospective analysis of literature published in PubMed.EVIDENCE SYNTHESIS: Several recent retrospective registry studies have investigated the incidence of perioperative cardiac arrest; in non-cardiac surgery patients, the incidence is reported to range from 0.2 to 1.1 per 10,000 adults and from 1.4 to 4.6 per 10,000 children.CONCLUSIONS: Successful management of cardiac arrest during surgery and beyond requires not only individual technical skills and a well-organized team response, but also an institutional safety culture embedded in everyday practice through continuous education, training and multidisciplinary cooperation. Evidence based guidelines and standardized treatment algorithms addressing the particularities of peri-operative cardiac arrest would be helpful to facilitate training. Existing guidelines are not comprehensive enough to cover specific aspects in depth; for the future, more detailed and more explicit guidelines are required.